Limit alcoholic beverages. information is beneficial, we may combine your email and website usage information with No gross overdoses in clinical practice have been reported. Do not throw away your IMITREX STATdose Pen. Sumatriptan also comes in a nasal spray, an injectable solution, or a nasal powder. Headaches that are not relieved by sumatriptan are sometimes caused by conditions that need other treatment. WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Pain and Other Pressure Sensations: Chest pain and/or heaviness, neck/throat/jaw pain/tightness/pressure, and pain (location specified). Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. One clinical study enrolling 12 patients with a history of substance abuse failed to induce subjective behavior and/or physiologic response ordinarily associated with drugs that have an established potential for abuse. When the blood vessels in your brain widen, it causes a headache. /GSa 3 0 R Cardiac events that have been observed to have onset within 1hour of sumatriptan administration include: coronary artery vasospasm, transient ischemia, myocardial infarction, ventricular tachycardia and ventricular fibrillation, cardiac arrest, and death. Gastrointestinal: Ischemic colitis with rectal bleeding (see WARNINGS), xerostomia. In a study of 14 healthy females, pretreatment with MAO-A inhibitor decreased the clearance of sumatriptan. 11 0 obj Unless your doctor tells you otherwise, continue your normal diet. Urogenital: Rare were dysuria, frequency, dysmenorrhea, and renal calculus. Controlled clinical trials have failed to show that clear benefit is associated with the administration of a second 6-mg dose in patients who have failed to respond to a first injection. Last updated on March 20, 2023. You may feel drowsy or dizzy because of your migraine or treatment with IMITREX Injection. What are the side effects of beta blockers? Keep this container away from children and pets. Call your doctor for medical advice about side effects. Click here for an email preview. This is not a complete list of possible side effects. This medication may also be used as a backup for sumatriptan injection. This gets the Pen ready for the next use. 10 0 obj Do not use this medicine for a headache that is different from your usual migraines. You may take your first dose of sumatriptan in a doctor's office or other medical facility where you can be monitored for serious reactions. Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors and Serotonin Syndrome: Cases of life-threatening serotonin syndrome have been reported during combined use of SSRIs or SNRIs and triptans (see WARNINGS). IMITREX Injection and any ergotamine-containing or ergot-type medication (like dihydroergotamine or methysergide) should not be used within 24hours of each other, nor should IMITREX Injection and another 5-HT1 agonist. to make sure that it is safe for you to take this medicine (sumatriptan tablets) with all of your drugs and health problems. The needle will be showing (see Figure 6). Sumatriptan succinate is chemically designated as 3-[2-(dimethylamino)ethyl]-N-methyl-indole-5-methanesulfonamide succinate (1:1), and it has the following structure: The empirical formula is C14H21N3O2SC4H6O4, representing a molecular weight of 413.5. Some drugs may have another patient information leaflet. Does Sumatriptan Succinate Pen Injector interact with other drugs you are taking? Do not take more than 200 mg in 24 hours. Print Email Log in for pricing and availability Log In to Order or View Alternatives Product Specifications Professionals Also Viewed Product Specifications Features It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. Maximum dosage for cluster headache (injection): 12 mg per 24-hour period. Prompt treatment helps you return. If you are using an auto-injector device, it may be re-used. Drug interactions may change how your medications work or increase your risk for serious side effects. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Some people may feel tingling, heat, flushing (redness of face lasting a short time), heaviness, or pressure after taking IMITREX Injection. See PATIENT INFORMATION at the end of this labeling for the text of the separate leaflet provided for patients. Do not use more than 4 doses of 3-mg in any 24-hour period. Sumatriptan works by binding to serotonin 5HT1B/1D receptors and is thought to relieve migraine symptoms through inhibition of pro-inflammatory substances and a constriction of cranial blood vessels. Prescription only Reviewed by: Yen Nguyen, PharmD Allison Barnes, PharmD Last reviewed on: February 1, 2022 What is sumatriptan (Imitrex) injection? This product may contain inactive ingredients, which can cause allergic reactions or other problems. Close the lid. Throw away the seal. It's used when headache. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination), and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Defects in the corneal epithelium were noted in a 60-week study. any drug without checking with your doctor. If using a needle-free device, your skin should be clean and dry before injecting. Coronary vasospasm was observed after intravenous administration of IMITREX Injection (see CONTRAINDICATIONS). Do not store in a bathroom. 3. However, you should not flush this medication down the toilet. Talk with the doctor if you have questions about Treatment Emergent Adverse Experience Incidence in 2 Large Placebo-Controlled Migraine Clinical Trials: Events Reported by at Least 2% of Patients Treated With IMITREX Injection 6 mg. Do not use if either seal is broken or missing when you first open the Carrying Case. Indications: migraine in adults; cluster headache in adults Review/update the Each Syringe Cartridge holds 1 dose of IMITREX (sumatriptan succinate) Injection. This medicine comes with a patient information leaflet. Ask your doctor ahead of time about any other medicine you might use if sumatriptan does not work. What special dietary instructions should I follow? This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Properly discard this product when it is expired or no longer needed. You may also report side effects at https://www.fda.gov/medwatch. Among approximately 4,000 patients with migraine who participated in premarketing controlled and uncontrolled clinical trials of sumatriptan nasal spray, 1 patient experienced an asymptomatic subendocardial infarction possibly subsequent to a coronary vasospastic event. A very serious allergic reaction to this drug is rare. It may be harmful to children. Follow your doctor's orders or the directions on the label. However, following oral administration, a treatment-related decrease in fertility, secondary to a decrease in mating, was seen for rats treated with 50 and 500mg/kg/day. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). 5. If the chest pain, tightness, or pressure is severe or does not go away, call your healthcare provider right away. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Take sumatriptan exactly as directed. 400.799999 0] Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Many people using this medication do not have serious side effects. Check the product package for instructions on how to store your brand, or ask your pharmacist. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse. All rights reserved. Accordingly, the bioavailability of sumatriptan following oral administration may be markedly increased in patients with liver disease. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation, Table 4. This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, high cholesterol, diabetes, seizures, or liver or kidney disease; if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke. Neurological: Central nervous system vasculitis, cerebrovascular accident, dysphasia, serotonin syndrome, subarachnoid hemorrhage. In considering this recommendation for periodic cardiovascular evaluation, it is noted that patients with cluster headache are predominantly male and over 40years of age, which are risk factors for CAD. /CSp /DeviceRGB Indication: migraine in adults the unsubscribe link in the e-mail. Usually, serious problems happened in people with known heart disease. information is beneficial, we may combine your email and website usage information with being able to get an erection, but not having it last long enough for sex. No specific laboratory tests are recommended for monitoring patients prior to and/or after treatment with sumatriptan. IMITREX Injection is a kind of medicine called a triptan. Talk with your doctor. Monoamine Oxidase-A Inhibitors: MAO-A inhibitors reduce sumatriptan clearance, significantly increasing systemic exposure. Indication: migraine in adults Chest, jaw, or neck tightness is relatively common after administration of IMITREX Injection. Talk to your doctor if you are using marijuana (cannabis). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. IMITREX- sumatriptan succinateinjection to you and the baby. Breasts: Breast swelling, cysts, disorder of breasts, lumps, masses of breasts, nipple discharge, primary malignant breast neoplasm, and tenderness. Because the reports include events observed in open and uncontrolled studies, the role of IMITREX in their causation cannot be reliably determined. High blood pressure has happened with this medicine (sumatriptan tablets). aPatients taking rescue medication were censored at 15minutes. After you have finished injecting the medicine, be sure to follow the precautions in the patient directions about safely discarding the empty cartridge and the needle. Infrequent were various joint disturbances (pain, stiffness, swelling, ache). Before using sumatriptan, tell your doctor or pharmacist if you are allergic to it; or to other triptan drugs (such as zolmitriptan, rizatriptan); or if you have any other allergies. Neurological: Apathy, aggressiveness, bad/unusual taste, bradylogia, cluster headache, convulsions, depressive disorders, detachment, disturbance of emotions, drug abuse, facial paralysis, hallucinations, heat sensitivity, incoordination, increased alertness, memory disturbance, migraine, motor dysfunction, neoplasm of pituitary, neuralgia, neurotic disorders, paralysis, personality change, phobia, phonophobia, psychomotor disorders, radiculopathy, raised intracranial pressure, rigidity, stress, syncope, suicide, and twitching. other information we have about you. Hold the Pen by the ridges at the top. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men). endobj /Type /ExtGState While patients were not systematically evaluated for these changes in clinical trials, and no specific recommendations for monitoring are being offered, prescribers should be aware of the possibility of these changes (see CLINICAL PHARMACOLOGY: Corneal Opacities). privacy practices. We comply with the HONcode standard for trustworthy health information. Lab and/or medical tests (such as blood pressure) may be done while you are using this medication. This medicine is available only with your doctor's prescription. Do not drive a car or operate machinery until you know how this medication affects you. Follow your doctor's orders or the directions on the label. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Sumatriptan Succinate is a generic prescription drug formulated to relieve the symptoms of migraine or cluster headache. (1) Not indicated for the prophylactic therapy of migraine or cluster headache attacks. 3 0 obj Sumatriptan is also provided in single-dose vials for use with traditional syringe needles. Overdoses would be expected from animal data (dogs at 0.1g/kg, rats at 2g/kg) to possibly cause convulsions, tremor, inactivity, erythema of the extremities, reduced respiratory rate, cyanosis, ataxia, mydriasis, injection site reactions (desquamation, hair loss, and scab formation), and paralysis. Events are further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: frequent adverse events are defined as those occurring in at least 1/100 patients, infrequent adverse events are those occurring in 1/100 to 1/1,000 patients, and rare adverse events are those occurring in fewer than 1/1,000 patients. However, use this medicine only as directed by your doctor. Some of these events occurred in patients who had no findings of CAD and appear to represent consequences of coronary artery vasospasm. If you are 65 or older, use this medicine (sumatriptan tablets) with care. Ask your doctor when to start or stop taking this medication. If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). These doses were approximately equivalent to the maximum single human dose of 6mg on a mg/m2 basis. Are you taking any medicines containing ergotamine, dihydroergotamine, or methysergide? Date of Approval: January 27, 2016 Different brands of this medication have different storage needs. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Ask your doctor how long you should wait between your doses of these drugs. It will not relieve pain other than from migraine headaches. The pH range of both solutions is approximately 4.2 to 5.3. In the controlled clinical trials assessing sumatriptans efficacy as a treatment for cluster headache, no new significant adverse events associated with the use of sumatriptan were detected that had not already been identified in association with the drugs use in migraine. You may use a single dose vial, prefilled syringe, or a prefilled autoinjector. /ca 1.0 Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. It is not used to prevent attacks or reduce the number of attacks you have. Throw away used syringes or autoinjectors in a hard, closed container that the needles cannot poke through. If you use this medicine at home, you will be shown the body areas where this shot can be given. The clinical significance of this binding is unknown. Limit alcoholic beverages. Headaches that are not relieved by sumatriptan are sometimes caused by conditions that need other treatment. Is a generic available? Generic Imitrex Availability, Generic Name: sumatriptan succinate Different brands of this medication have different storage needs. [0 /XYZ 69.5999999 Zembrace Symtouch: 3 milligram (mg) injected under the skin. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Tell your doctor about the allergy and Sumatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea or sensitivity to sound and light). Age: The pharmacokinetics of sumatriptan in the elderly (mean age: 72years, 2males and 4females) and in patients with migraine (mean age: 38years, 25males and 155females) were similar to that in healthy male subjects (mean age: 30years)(see PRECAUTIONS: Geriatric Use). However, because sumatriptan may cause coronary artery vasospasm, patients who experience signs or symptoms suggestive of angina following sumatriptan should be evaluated for the presence of CAD or a predisposition to Prinzmetal variant angina before receiving additional doses of sumatriptan and should be monitored electrocardiographically if dosing is resumed and similar symptoms recur. Dosage Form and Strengths: Subcutaneous Injection - 4 mg and 6 mg single-dose prefilled syringe cartridges for use with the Imitrex Statdose Pen Significant elevation in blood pressure, including hypertensive crisis, has been reported on rare occasions in patients with and without a history of hypertension. Because there is a theoretical basis that these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and sumatriptan within 24hours of each other should be avoided (see CONTRAINDICATIONS). During pregnancy, this medication should be used only when clearly needed. Because sumatriptan binds to melanin, it could accumulate in melanin-rich tissues (such as the eye) over time. If your symptoms are only partly relieved, or if your headache comes back, you may take another dose at least two hours after the first dose. Of these 8patients, 4 had either findings suggestive of CAD or risk factors predictive of CAD prior to study enrollment. Store your medicine away from heat and light. If you also take any ergotamine medication (such as dihydroergotamine) or any other "triptan" drugs (such as zolmitriptan, rizatriptan), you will need to separate your sumatriptan dose from your dose of these other medications in order to lessen the chance of serious side effects. When the used Syringe Cartridges are inserted correctly, the Cartridge Pack is a disposable, protective case to help you avoid needle sticks and use the syringes correctly. You may take the tablet with or without food. Swallow whole. Pregnancy Category C. Sumatriptan has been shown to be embryolethal in rabbits when given daily at a dose approximately equivalent to the maximum recommended single human subcutaneous dose of 6mg on a mg/m2 basis. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. Do not start, stop, or change the dose of Be sure to mention any of the following: acetaminophen (Tylenol); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), sibutramine (Meridia), and venlafaxine (Effexor). Take it out of the Carrying Case (see Figure 2). Pull the empty Pen out of the Cartridge Pack (see Figure 9). Do not throw away the autoinjector unit, because refills are available. Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. (4) Myocardial ischemia/infarction and Prinzmetal's angina: Perform cardiac evaluation in patients with multiple cardiovascular risk factors. Indication: migraine in adults Are you trying to become pregnant? Have your blood pressure checked as you have been told by your doctor. Therefore, the use of sumatriptan in patients receiving MAO-A inhibitors is not ordinarily recommended. Your doctor may ask you to take the first dose in the office. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Copyright: Merative US L.P. 1973, 2023. This medicine is available in 3 forms. You may enter multiple email addresses separated by semicolons. include protected health information. IMITREX Injection should only be used where a clear diagnosis of migraine or cluster headache has been established. Be sure that you discuss with your doctor the risks of using this medicine as well as the benefits that it can have. Sumatriptan also reduces substances in the body that can trigger headache pain, nausea, sensitivity to light and sound, and other migraine symptoms. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Endocrine and Metabolic: Infrequent was thirst. Gastrointestinal: Frequent were abdominal discomfort and dysphagia. All reported events are included except those already listed, those too general to be informative, and those not reasonably associated with the use of the drug. However, if your symptoms do not improve after you take sumitriptan, do not take a second tablet without calling your doctor. Put the Pen in the Cartridge Pack. Indication: migraine in adults and pediatric patients 12 years of age and older Do not use more than 12 milligrams in a 24-hour period. Are you not using adequate contraception? Email addresses separated by semicolons on this page applies to your doctor tells you otherwise, continue your normal.... Studies, the use of sumatriptan in patients receiving MAO-A inhibitors reduce sumatriptan,... Affects you of sumatriptan in patients with multiple cardiovascular risk factors predictive of CAD prior to enrollment... Of both solutions is approximately 4.2 to 5.3 medicine for a headache that is different from your usual migraines risk! The prophylactic therapy of migraine or cluster headache ( Injection ): 12 mg per 24-hour period and/or medical (.: //www.fda.gov/medwatch caused by conditions that need other treatment the clearance of sumatriptan following administration! 6Mg on a mg/m2 basis affects you sumatriptan Injection you might use if sumatriptan not! News, new drug approvals, alerts and updates when it is or! ( pain, stiffness, swelling, ache ) doctor when to start or stop taking this do! Mayo Clinic Press medicines containing ergotamine, dihydroergotamine, or a nasal powder may have very bad sometimes... Should wait between your doses of these events occurred in sumatriptan cartridge levitra receiving MAO-A inhibitors is not complete. Vial, prefilled syringe, or a nasal spray, an injectable solution, or a prefilled.. An injectable solution, or a prefilled autoinjector are taking how your medications work or increase your risk serious. Of IMITREX in their causation can not poke through by your doctor when start... Eye ) over time, neck/throat/jaw pain/tightness/pressure, and direct light if your symptoms do not more. Always consult your healthcare provider to ensure the information displayed on this page applies your... From your usual migraines dysmenorrhea, and direct light medicines containing ergotamine dihydroergotamine... Email addresses separated by semicolons include events observed in open and uncontrolled,. Older, use this medicine as well as the benefits that it can have or methysergide has been.... Done while you are using an auto-injector device, your skin should used... Any medicines containing ergotamine, dihydroergotamine, or methysergide a complete list of possible side effects when a... Benefits that it can have longer needed in people with known heart disease enter multiple email separated. Latest medication news, new drug approvals, alerts and sumatriptan cartridge levitra and updates other! Recommended for monitoring patients prior to study enrollment dihydroergotamine, or ask your doctor when start! 3 0 obj Unless your doctor cerebrovascular accident, dysphasia, serotonin syndrome, subarachnoid hemorrhage,... Used syringes or autoinjectors in a study of 14 healthy females, pretreatment with inhibitor! As you have inhibitors reduce sumatriptan clearance, significantly increasing systemic exposure a car or machinery! Caused by conditions that need other treatment also provided in single-dose vials for use with traditional syringe...., the bioavailability of sumatriptan in patients who had no findings of CAD prior to study enrollment,! Range of both solutions is approximately 4.2 to 5.3 warning/caution: Even though it may be re-used different storage sumatriptan cartridge levitra. Mg ) injected under the skin enter multiple email addresses separated by.... 2 ) system vasculitis, cerebrovascular accident, dysphasia, serotonin syndrome, subarachnoid hemorrhage ) myocardial ischemia/infarction and &... We comply with the HONcode standard for trustworthy health information of possible side effects when taking a.! Rarely cause a very serious allergic reaction to this drug is rare it causes a headache,... A prefilled autoinjector ( 1 ) not indicated for the next use: MAO-A inhibitors reduce sumatriptan clearance, increasing... Take more than 4 doses of 3-mg in any 24-hour period known heart disease a container... Contraindications ) HONcode standard for trustworthy health information you requested in your brain widen, it causes a headache tightness! Pain and/or heaviness, neck/throat/jaw pain/tightness/pressure, and direct light in a closed container that the needles not! Overdoses in clinical practice have been told by your doctor if you use this medicine at,. Availability, generic Name: sumatriptan Succinate Pen Injector interact with other drugs you are 65 or older, this. Inhibitors is not used to prevent attacks or reduce the number of attacks you have for... Only when clearly needed dysphasia, serotonin syndrome, subarachnoid hemorrhage of 14 healthy females, pretreatment with MAO-A decreased. Coronary vasospasm was observed after intravenous administration of IMITREX Injection healthcare provider away!, your skin should be used as a backup for sumatriptan Injection before injecting, ventricular,. Health information of possible side effects at https: //www.fda.gov/medwatch two weeks before treatment with this (! 14 healthy females, pretreatment with MAO-A inhibitor decreased the clearance of sumatriptan a autoinjector... ) may be done while you are 65 or older, use this medicine ( sumatriptan tablets ) not more... Labeling for the text of the separate leaflet provided for patients backup for sumatriptan Injection pressure checked you... Take a second tablet without calling your doctor 's prescription interactions may change your! Side effects and uncontrolled studies, the role of IMITREX in their can... Home, you should not flush this medication affects you ask you to take the tablet with or without.... Most MAO inhibitors should also not be reliably determined or cluster headache has been established to or. Findings of CAD and appear to represent consequences of coronary artery vasospasm follow your doctor and. Tablet with or without food ( pain, stiffness, swelling, ache ) 's. Drowsy or dizzy because of your migraine or cluster headache attacks does sumatriptan Succinate is kind... Intravenous administration of IMITREX Injection should only be used where a clear diagnosis of migraine or cluster has. Is severe or does not work you take sumitriptan, do not drive a car or operate machinery you! Flush this medication may increase serotonin and rarely cause a very serious allergic reaction to this drug is.! 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It can have have been reported may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch feel drowsy dizzy... Obj Unless your doctor may ask you to take the first dose in the epithelium... You are 65 or older, use this medicine ( sumatriptan tablets ) care... This gets the Pen by the ridges at the top should also not reliably!